My wife gets migraines. Not just run of the mill, every day migraines, but the truly debilitating type that leave her weeping and in pain for days at a time. To combat the migraines, she takes an interesting mix of drugs and recently added Botox to her regimen--a series of shots in her neck, her shoulders, above her eyebrows, and on the sides of her head that, somehow, help tremendously in alleviating her pain. The drugs she takes daily, the Botox comes once a quarter.

We both like her doctor, a smallish woman with a dry (and occasionally violent) sense of humor and who threatened to stick me with a shot of Botox just so I could see how much it stings. She was joking, I’m pretty sure.

During one of the appointments, we ended up chatting about the various “alternative” treatments that darling girl has tried to control the migraines. At mention of some of the treatments (like craniosacral therapy), she rolled her eyes at about the same time I did. Big laughs ensued.

My opposition to some of these treatments wasn’t just that there was limited evidence of effectiveness, but that she sometimes seemed to come back in more pain than when she had gone to her therapist. To me, it was just a sign of desperation--understandable desperation--that she kept trying when the various mixes of drugs seemed to lose their effectiveness. But knowing just how much she was hurting, I really did understand her drive to find something that would help. As I said, entirely understandable.

When we left the doctor that day, we kept talking about the different treatments, about how happy we were that the Botox was working (even though it paralyzes her eyebrows, a fact that bothers her more than I expected). She explained that sometimes she kept trying the stuff that made me roll my eyes because it made her feel better even if, logically, she wasn’t sure that it was making any difference.

I suddenly understood. What she wanted was something that worked regardless of whether it was effective (which is the only way I can formulate such an imperfect thought)--until it stopped working, a placebo that did nothing other than making her feel less pain was just as good (and, sometimes, better) than a drug that played havoc with her brain and that had limited effectiveness is warding off the migraines. Some of those drugs made her feel sick whenever she ate, played with her short term memory, and some even seemed to give her more migraines. When faced with side effects like those and all the uncertainty that comes with changing the drug regimen, a metaphorical sugar pill with no down side has to be attractive.

What she wouldn’t give for a really good placebo.

Which is why this article struck me as funny today.

Some products that have been on the market for decades, like Prozac, are faltering in more recent follow-up tests. In many cases, these are the compounds that, in the late ‘90s, made Big Pharma more profitable than Big Oil. But if these same drugs were vetted now, the FDA might not approve some of them. Two comprehensive analyses of antidepressant trials have uncovered a dramatic increase in placebo response since the 1980s. One estimated that the so-called effect size (a measure of statistical significance) in placebo groups had nearly doubled over that time.

It’s not that the old meds are getting weaker, drug developers say. It’s as if the placebo effect is somehow getting stronger.

The fact that an increasing number of medications are unable to beat sugar pills has thrown the industry into crisis. The stakes could hardly be higher. In today’s economy, the fate of a long-established company can hang on the outcome of a handful of tests.
Why are inert pills suddenly overwhelming promising new drugs and established medicines alike?

Interesting article (if you’re into that sort of thing), and it made me look a little differently at the different things that darling girl goes through to try to control her pain. Not that I’ll stop rolling my eyes; that’s just not me. But I’ll try to do it a little quieter from now on.